The pathogenesis of pelvic organ prolapse (POP) is unknown. Few studies have correlated patient symptoms and amount of prolapse with biomarkers. POP has traditionally been managed with a pessary or surgery. Recent studies suggest a reduction in POP symptoms following Pelvic Floor Physical Therapy (PFPT). Vaginally delivered hormones are also commonly used to treat prolapse symptoms, with little evidence supporting a clinical benefit. The investigators hypothesize that the optimal approach to improving prolapse symptoms in the patient with mild prolapse requires re-alignment and strengthening of levator muscles via PFPT, and optimization of tissue integrity via local estrogen therapy. The investigators propose to test this hypothesis in a randomized controlled trial in which women with symptomatic mild prolapse opting for PFPT, receive treatment with PFPT in combination with vaginal estrogen versus placebo. The investigators predict that the combined approach will lead to decreased symptoms, and improved anatomical support corroborated by biomarker data.

Unevaluated abnormal vaginal bleeding or a pap smear showing atypical glandular cells, ASCUS, LGSIL, or HGSIL in the previous year

BMI > 35 kg/m2

Estrogen therapy (including birth control) in the previous year (patients using progesterone alone will be included)

Current or prior breast or pelvic malignancy (ovarian, tubal, uterine, cervical or vaginal)

Contraindication to hormone use (i.e. thromboembolic disorder, use of anti-coagulants, coronary artery disease, history of stroke)

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Please refer to this study by its ClinicalTrials.gov identifier: NCT01648751